Provider Demographics
NPI:1174256051
Name:LEONID R BRISKIN DMD PA
Entity Type:Organization
Organization Name:LEONID R BRISKIN DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONID
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRISKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-475-8100
Mailing Address - Street 1:8320 W SUNRISE BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-5434
Mailing Address - Country:US
Mailing Address - Phone:954-475-8100
Mailing Address - Fax:954-475-4072
Practice Address - Street 1:8320 W SUNRISE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-5434
Practice Address - Country:US
Practice Address - Phone:954-475-8100
Practice Address - Fax:954-475-4072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty